Mental Health Services in Britain’s Women’s Prisons Are Still a Mess

A dorm in Holloway prison. All photos are from inside Holloway prison

*Names have been changed to protect the identities of prisoners

Pink butterfly stickers were pasted all over light blue walls inside Katleen’s* cell. The 28-year-old of Romany Gypsy origin peered through the hatch of her door as she told me about her experience of mental health provision in prison.

“My probation officer referred me for mental heath services 15 months ago, but no one has come to see me yet. I was feeling very low. They offered me a single cell but I refused to go in one. My son and my mother had just died; I was having thoughts.”

As we spoke, Holloway prison was about to be shut down. When Katleen first arrived here, she was at risk of suicide. Being allocated a shared cell helped because “I would get support from the girls that I’ve been sharing with.”

Her story is not unusual. In 2014, The Prison Reform Trust revealed that female inmates are more than three times as likely to be identified as suffering from depression as women in the general population. The same report found that w omen’s offending is more likely to be prompted by their relationships or by financial concerns, and that 81 percent of women in custody have been convicted of non-violent offences.

Jenny Earle, programme director for Reducing Women’s Imprisonment at Prison Reform Trust, told me: “For women who do need to be in prison because of serious offending, it’s critical that the care available in prisons is trauma-informed because of the evidence that women’s mental health [problems], including depression and anxiety, are often due to experiences of victimisation, abusive and coercive relationships.”

“However, if there was better access to community-based mental health care, fewer women might end up in prison,” she added.

Over in Holloway’s drug rehab, I spoke to Charlene, 37*, over a cup of tea. Tall and bubbly, she hails from Highbury and is of English and Caribbean origin. “I was coming off crack when I came here,” she said. “I was worried that I might have bi-polar disorder because of the intensity of the emotions and because my mum has bi-polar.”

She requested to see a mental health worker when she first arrived, but had to wait for five months. “The joke of it is, by the time someone came to see me I was alright. All it was was that all the emotions I blocked down began to surface when I stopped smoking crack.”

Despite the bad things I was told by its inmates, Holloway’s mental health services were relatively well developed. Before it shut, it even had a therapeutic garden. “They had good services, but it was just too big,” explained former inmate and drug worker Mandy Ogunmokun. “It’s like finding a needle in a haystack. It would be better for a lot of the women to go to a smaller custodial units to do their sentences. They’d be able to get more individual attention.”

In 2007, Baroness Corston conducted a report into vulnerable women in the criminal justice system following the tragic deaths of six women at Styal prison in Cheshire. She recommended to the House of Lords that smaller custodial units should be set up and community sentences for women convicted of non-violent offences introduced. The recommendations haven’t still been implemented.

Andy Bell of the charity Centre for Mental Health – a leading authority in the UK’s mental health research – says that every police station and court should have a liaison and diversion service for people with mental health problems, and that vulnerable females should be offered support before it reaches the stage where custody looks likely. “There should to be someone recognising the needs, advising the police and courts how to help that person,” he explained. “And if they do end up in prison, they should have access to the same level of care as in the community. We need national standards of prison mental health care by the NHS.”

When Holloway closed in May, inmates were shipped out to Downview and Bronzefield prisons in Surrey.

One of the main concerns noted within the 2016 Independent Monitoring Board’s annual report on the closure of Holloway prison was “about the mental health provision which would be available to women in other prisons after the closure of Holloway” – because those other prisons are judged to be even worse.

Inmates at Downview say they spend 23 hours a day in their cells with little access toprofessional support. As a “works prison”, everything they do is geared towards getting the women work-ready for release. When asked for comment on the mental health services at Downview, the Home Office did not respond.

Over at Bronzefield, a privatised prison run by Sodexo, the women say that provision is sparse. Doing time there is containment, not rehabilitation.

A spokesperson for the prison responded: “Her Majesty’s Inspector of Prisons report found earlier this year HMP Bronzefield was a well-led prison showing continuous improvement. Primary mental health services are delivered by Sodexo and include an enhanced primary mental health pathway, which includes an Improving Access to Psychological Therapies (IAPT) service and embeds psychological support services. This will be supported by a wellbeing programme, which is currently being developed.”

“Their services must still be in foetal stages, because when I was in there it was disgusting,” 27-year-old Nisreem*, from Maida Vale, told me.

She was recently released from the prison and seemed agitated as we talked. “The whole health care department was a joke,” she said. “I had a toothache for six weeks and I wasn’t able to see anyone. My girlfriend in there suffers from a borderline personality disorder, but no one came to see her. It was left to me to support her.”

There are now twice as many women in prison in England and Wales than there were in 1995, and many are serving short sentences. In 2014, those entering prison to serve sentences of less than 12 months accounted for 71 percent of all women entering prison under an immediate custodial sentence – a short sentence – in comparison to 55 percent of males.

The results of a group therapy session in Holloway

Near Manchester airport, at HMP Styal, which holds 460 women, I made another pit-stop to see Tracey McMahon, who runs the charity SHE.

SHE takes referrals from Styal for women who need housing and support after prison, including access to mental health services. “Short-term sentences impact the wellbeing of women due to the losses occurred, such as homes, children and possessions,” she said. “In particular, where they may have had a ‘caring’ role prior to custody.”

Styal is also a remand centre, and if women are acquitted or released straight from court they don’t receive any support upon exiting custody. “Provision of mental health services in there are infrequent; this is identified through women who are serving short sentences,” said McMahon. “On entry into custody, previous mental health support in the community is curtailed and women on short sentences are often left without vital support during their time there. The long and short of this is that those who are truly poorly are the ones who are in prison when they should be in hospital.”

I asked the MoJ press office to comment on these issues and they said this was a matter for NHS England. Unfortunately, NHS England didn’t respond to a request for a comment.

As of the 21st of October, 2016, there were 3,857 women in custody. Holloway was closed because its design was said to provide a poor environment for rehabilitation. But what seems clear now is that the problem of mental health care in women’s prisons is more systemic than specifc, and reaches far beyond Holloway’s walls.

Scroll down for more pictures from inside Holloway

Prison snacks

A decorated toilet

Canteen Fridays – the canteen system is how prisoners are allowed to buy certain items

Sanitary towels obscure the view of the screws into a cell by covering a security mirror

Our Aims: About Us

To support users and ex-users of psychiatric services in the Manchester area. The organisation provides a forum for services users to have a bona fide say in planning and provision of mental health services.

Protesters in King’s Lynn fight against mental health service cuts

Protesters took to the streets of King’s Lynn to voice their anger at what they described as “continuous” cutbacks to mental health services in west Norfolk.

Mental health cuts protest

A protest march against cuts to mental health services and the Fermoy Unit at the QEH took place in King's Lynn town centre. Picture: Matthew Usher.

More than 100 campaigners marched from The Walks through the town centre before finishing outside the Majestic Cinema.

Peter Smith, former parliamentary candidate for south-west Norfolk said: “We are in the fight of our lives here.”

The protest was triggered by the Fermoy Unit, an in-patient NHS facility in Lynn for mental health, which campaigners say faces an uncertain future. The unit was briefly closed to new admissions earlier this month, but reopened last week, albeit with fewer beds.

Mr Smith said: “In my lifetime we have never had to fight like this, but what is the alternative?”

But Debbie White, director of operations for Norfolk at the Norfolk and Suffolk NHS Foundation Trust, said there were now no plans to axe the Fermoy Unit.

She added: “It is right that mental health services should be valued and funded on the same level as acute health services, and it is understandable people feel passionate about the Fermoy Unit remaining open.”

Labour party activist Jo Rust insisted the issue would not disappear. She said: “They have been talking about closing it for a long time. We will fight and we will not let them do that.”

Beth Anthony, 18 of Dersingham, said: “We are here to protest against the continuous cuts to the mental health service, we think it’s unacceptable. My younger brother suffers from poor mental health and has to travel to London... That is to the detriment of my family because we have to pay for him to go down by train every single month.”